The Nurse’s Role in Caring for Patients Receiving Dialysis
One of the International Society of Nephrology’s latest reports describes the results of the Kidney Disease: Improving Global Outcomes (KDIGO) Workshop on the role of nurses in caring for patients receiving dialysis.
The report highlights the importance of empowering nurses to share their experiences to influence or become policy-makers and leaders. Nurses spend a substantial amount of time with patients receiving dialysis and so are uniquely positioned to speak to the high symptom burden and needs of these patients.
The report also describes ways to improve identification and management of symptoms of patients receiving dialysis, including:
• Using Patient-Reported Outcome Measures (PROMs) to ensure alignment with patient’s goals and needs.
• Remote monitoring with technology-based solutions to allow for proactive and timely symptom management
• Empowering nurses with in-depth education and shared decision-making skills.
• Supporting patients with patient peer support programming
Alternative Treatment Pathways for Patients who Choose to Forgo Dialysis
For certain patients, dialysis may not be the right choice based on their quality of life goals. Alternative treatment pathways exist, and a recent article by Dr. Hyde at the Center to Advance Palliative Care (CAPC), with contributions from the Coalition for Supportive Care of Kidney Patients, highlights Conservative Kidney Management (also referred to as Active Medical Care Without Dialysis) as one of those options. Some key points from the article include:
- CKM prioritizes quality of life, symptom management, and shared decision-making for patients who may not benefit from dialysis due to comorbidities, frailty, or limited life expectancy.
- Good candidates for CKM include older adults with multiple comorbidities, patients with reduced functional status, those with limited life expectancy, and individuals with strong preferences against dialysis.
- The article outlines a shared decision-making framework that includes assessing patient goals and values, clearly presenting treatment options, discussing prognosis compassionately, eliciting patient preferences, and supporting patient decisions.
- Key components of CKM include symptom management, nutritional support, psychosocial and emotional support, and advance care planning, with an emphasis on effective communication throughout the process.
Shared Decision-Making: Moving from When to How
In a recent article in the Journal of General Internal Medicine, Opel et al suggest that it is time move away from focusing on when Shared Decision-Making (SDM) should be used and instead concentrate on how to effectively implement SDM across various clinical contexts. The authors suggest that SDM is most valuable not in situations of evidence uncertainty but where multiple evidence-backed options involve trade-offs that matter to patients.
The Coalition work on the ExPAND Project is focused on similar themes of shared decision-making implementation and the development of kidney supportive care programming. Learn more here.